Communicating Health Risks to the Public

A Global Perspective

Dawn Hillier, Dawn Hillier

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317163657
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This book reviews current health risk communication strategies, and examines and assesses the technical and psycho-sociological tools available to support risk communication plans. It brings together approaches to risk communication from a number of countries and describes the techniques, including drama, storytelling and scenarios that are used to identify and prioritise key communication issues, and to identify policy responses. The book also provides a review of the methods and tools available for risk assessment, risk communication and priority setting, which are relevant not only to practitioners but to health planning more generally, and to many other areas of public health and policy. The discussion of these techniques is supported by case studies, and is concluded by a chapter reflecting on the conceptual and research issues that still need to be addressed. It also proposes new directions for risk communication that key into the public imagination with the aim of gaining their trust and confidence in the risk messages. Communicating Health Risks to the Public: A Global Perspective brings together a wide variety of perspectives on risk communication, from the perspectives of health, anthropology, psychology, and media. It should be of interest not only to those involved in risk assessment or communication but to anyone interested in the role of science and the media in the political process.

CHAPTER 1 Introduction

The World Health Organization (WHO) has identified ten leading risk factors for preventable death and disease worldwide: maternal and child underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe water, poor sanitation and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency; and high body mass index (BMI), or overweight. WHO hypothesises that 40 per cent of deaths worldwide are due to these ten risk factors alone; global healthy life expectancy could be increased by five to ten years if individuals, communities, health systems and governments took action to reduce these risks by attending to behaviour-change strategies and actions. These actions depend on a complex set of human and societal processes

This chapter provides a broad overview of risk focusing on the various dimensions that affect health risk. These range from consideration of aspects of the risk society, medical-ecology, economics, environmental, socio-political, human-emotional, technological, legal and regulatory (threshold risks), epidemiological mobility to accessibility of health care.

Without risk there is no opportunity for gain

Controversies about risks to public health regularly attract news headlines, whether about food safety, environmental issues, medical interventions, or lifestyle risks such as drinking. To those trying to manage or regulate risks, public reactions sometimes seem bizarre. To the public, the behaviour of those supposedly in charge can seem no less strange. Trust is currently at a premium. Risk has become big business with thousands of consultants providing advice on ‘risk assessment’, ‘risk analysis’, ‘risk management’ and ‘risk communication’. The media has become increasingly interested in the subject and terms such as ‘risk society’ and ‘risk perception’ regularly grace the pages of newspaper columns and feature on television documentaries and news programmes.

According to Furedi (2002, 5) there are so many apparently expert voices attempting to alert us to new dangers that their advice often seems to conflict and thus confusion reigns over exactly what is safe and what is risky. Safety has become one of the fundamental values of our age. For Furedi (2002, 1), passions that once drove the struggle to change the world (or to keep it the same), are now invested in trying to make sure that we are safe. The label ‘safe’ gives new meaning to a whole range of human activities, endowing them with unspoken qualities that are meant to merit our automatic approval. For example, ‘safe sex’ is not just sex practised safely – it implies an entire attitude towards sex and life in general. Moreover, personal safety is a growth industry with hardly a day going by without some new risk to the individual being reported, and another safety measure proposed.

Our inability to come to terms with local, national and global systems failure stems from the fact that television reduces political discourse to sound bites, and academia and medicine organises scientific and intellectual inquiry into narrowly specialised disciplines. As a result we become accustomed to dealing with complex issues, such as smoking, alcohol misuse or obesity, in fragmented components. Yet in the complex world in which we live nearly every aspect of our lives is connected in some way with every other aspect. Consequently, if we limit ourselves to fragmented approaches to dealing with universal health risk issues or natural events, it is not surprising that our solutions prove inadequate. If human beings are to survive the predicaments we have created for ourselves, a capacity for whole-systems thought and action must be developed. Whole-systems thought must include the environment, culture, politics, issues of power and control, institutions and so on.

This book brings together a wide variety of perspectives on risk communication, from the perspectives of health, culture, psychology, entertainment and media. It should be of interest not only to those involved in risk assessment or communication but to anyone interested in the role of science and the media in the political process.

It brings together approaches to risk communication from a number of countries and describes the techniques, including drama, storytelling and scenarios that are used to identify and prioritise key communication issues, and to identify policy responses.

The book also provides a review of the methods and tools available for risk communication and priority setting, which are relevant not only to practitioners but to health planning more generally, and to many other areas of public health and policy formation. The discussion of these techniques is supported by case studies, and is concluded by a chapter reflecting on the conceptual and research issues that still need to be addressed and proposals for different directions in risk communication that keys into the public imagination and gains trust and confidence in the risk messages.

Risks and hazards

Nearly all risk issues involve two hazards: the physical hazard itself (which for the purpose of this book includes risks concerning mental health or rather ill health), and the reaction to it. A lengthy list of examples, from anthrax in the United States mail, mad cow disease in the United Kingdom to SARS in the Far East, demonstrates that elevated fear of a risk is often a larger danger than the hazard itself. At the same time, less concern about a hazard than appropriate can also be dangerous, as is the case with heart disease, sun exposure, food poisoning or motor vehicle crashes. Risk misperception, then, is a hazard, whether the fear is too high, or too low. Take for example the following headline from the Mail on Sunday (UK, 8 May 2005):

At least 12 infected by victim who refuses all treatment
TB HUMAN TIMEBOMB

The medical correspondent Rachel Ellis alerts the general public to the risk to the public from a highly contagious form of tuberculosis (TB) because the authorities, that is the British Government and the medical profession, are powerless to make the individual who is potentially infecting other people accept medical treatment. The article lays the blame firmly at the feet of the Labour Government claiming that it was warned three years ago about the possibility of the TB time bomb in Britain. But it has failed to update Victorian quarantine laws and doctors say they can do nothing to prevent the person concerned passing on the deadly disease because he refuses proper treatment. Ellis claims that the Government now says that it can do nothing because it could breach disease carriers’ human rights. Moreover, because of the strict rules on patient confidentiality, the public cannot be warned who the infected person is.

In the context of this book, the aim is not to try to resolve the question of health risk perception or our responses to risk communication, but, in the first instance, to describe an approach or model of causes and consequences of risk communication which seems pertinent to the ethnography of risk communication in different cultures and societies. This lightens the burden somewhat since it would follow, at least from an anthropological perspective with its relativistic suppositions, that ethnography cannot be expected to describe more than an instant, one of the many possibilities, which are engendered by central foundational elements to risk communication as an historical process.

Communicating about risks to public health is of vital importance in many different cultural contexts, quite apart from its importance in government, the health services, local authorities, and the private and voluntary sectors. Because communication needs to be considered at all stages of risk analysis, whether in the village or in post-industrialised cities, it should concern all those dealing with actual or potential public health risks, including individuals, leaders, administrators, medical staff, and scientific and policy advisors.

This book brings two main perspectives to bear. One is that offered by empirical research on reactions to risk. This, for example, explores what influences trust, which types of risk are most likely to be seen as unacceptable or outrageous, how information about probabilities may be understood or misunderstood, and why comparisons between different risks are sometimes misleading. This psycho-cultural perspective is extended by considering the wider context – for example the role of the media in determining why some risks rather than others become major public issues or how health risk is or can be communicated through the media. We attempt to understand the privatisation of fault ascribed to certain groups in the context of public health risk, clearly identifying those with responsibility but no choice and those with no responsibility and plenty of choice in their action. We stress the need to guard against taking too narrow a view of the risk issues themselves. We need to understand the socio-cultural context of risk to avoid sending the wrong message, or choosing the right message but failing to convey it.

The second perspective considers risk communication as a decision-making process. Decisions about communication involve much more than just the choice of words and numbers. From this follows the need to consider communication styles and approaches.

Risk and society

For the purposes of this book, four distinct forms of risk are identified: risks that are related to purity, danger and pollution in Mary Douglas’s (1966) terms which are essentially locally based and bound up in concepts of spirituality, magic and nature; risks associated with local, technological and environmental dangers (Douglas and Wildavsky 1982). These two forms of risk can be grouped as follows at the level of public policy.

1 Foreign affairs: the risk of foreign attack or encroachment; war; loss of influence, prestige, and power.

2 Crime: internal collapse; failure of law and order; violence and abuse; white collar crime.

3 Pollution: abuse of technology and industry; fears for the environment.

4 Economic failure: loss of prosperity – low paid workers, unemployment; poverty and its impact on housing, water supply, waste disposal, transport, education, and so on.

5 Health: disease; accidents, and so on.

The third form of risk relates to socio-cultural risks that are concerned with social capital and status with a group; and the fourth perspective is concerned with Beck’s (1992) notion of risk, that is, the global exposure of people to risks generated by contemporary industrialised society, such as nuclear waste. During the modernisation phase, people had willingly accepted medical and ecological side effects in return for an increase in material welfare, however in the Western world:

... a double process is taking place now. On the one hand, the struggle for one’s ‘daily bread’ has lost its urgency as a cardinal problem overshadowing everything else, compared to material subsistence in the first half of this century, and to a Third World menaced by hunger. For many people problems of ‘overweight’ take the place of hunger... Parallel to that, the knowledge is spreading, that the sources of wealth are ‘polluted’ by growing ‘hazardous side effects’.

(Beck 1992, 20)

These side effects constitute risks and the distribution of these risks is becoming the central feature of a global society. It is not that the hazards themselves that are necessarily new but the way in which they are socially constituted are. Consequently, an important defining feature of risk is its social reflexivity. The risks of which Beck (op. cit.) speaks are primarily generated by industrialisation, and include threats from toxins, pollutants, radioactivity and nuclear waste, which may ultimately cause irreversible and invisible damage to the environment.

The contemporary experience of risk is bound to the concept of reflexive modernisation and is both scientifically and politically reflexive. Society is intentionally recast as an attempt to reduce risk but cannot deal with ‘the threatening force of modernisation and its globalisation of doubt’ (Beck 1992, 21) because contemporary risks are qualitatively different from the hazards and dangers experienced in previous periods of history.

The risks and hazards of today thus differ in an essential way from the superficially similar ones in the Middle Ages through the global nature of their threat (people, animals and plants) and through their modern causes. They are risks of modernisation. They are a wholesale product of industrialisation, and are systematically intensified, as it becomes global.

(Beck 1992, 21)

Risk, for Beck (1992), globalises because it universalises and equalises. It affects every member of the world population regardless of location and class position. Moreover it respects no borders. I would argue, however, that global risks do not necessarily equalise since wealthy, developed industrial countries are in a position to transport their risks, that is, their pollutants such as toxic waste to less-developed countries. In this way wealthy countries can play down their own risks while increasing risks elsewhere. Beck further argues that the only possible solutions to risk, therefore, are supranational solutions such as strategic arms reduction and international agreements on emission reduction or the proliferation of nuclear weapons.

From another perspective, one could argue that social institutions not only tend to standardise ways of life and lifestyle options on a national scale; they are involved in an ever-intensifying process of globalisation. In individualised societies like the United States or the United Kingdom, autonomy is always dependent on and restricted by the kind of institutions that give shape to the conditions of social life. On the other hand, this state of affairs makes clear that people have common interests in the quality of the institutions that they so heavily depend on. Exactly because of the penetrative effects of schools, universities, hospitals, social services and industrial companies on the individual life chances of each of us, everyone has a vested interest in the quality of the goods and services that such institutions deliver.

More important is the awareness that local events and personal actions have become heavily dependent on developments and decisions that have their origin in other parts of the world. At the same time, decisions and choices that we make here and now have a serious impact on the life chances of people living far away. For example, each and everyone’s adherence to uphold the standards of production and consumption of Western societies not only reinforces the unequal distribution of material welfare and life chances between the rich and poor countries of the world, it also contributes to the continuing exploitation of natural resources that endangers the life and future of coming generations.

Of course, these kinds of global interdependence may be and are ignored on a massive scale in everyday life, but it is no longer possible to deny their existence. That is why, I believe, that we cannot escape from our inherent responsibility for the destiny of other people while acting and choosing in local contexts and on behalf of our personal concerns – even if we do not know these others personally.

Whether one accepts the theories and arguments for global warming, some effects are being felt in parts of the world. For example, climate change has been blamed for vanishing shorelines, decreased crop yields and lower numbers of traditional game, which particularly affects the food supply and way of life for Canada’s Far North communities. In the tiny hamlet of Arctic Bay on Baffin Island, Nunavut, researchers have found that changes to the traditional diet are posing an even greater threat to public health.

People were always insecure, but now they are being threatened on a global scale from the risks of pollution and the poisoning of food and water, and the impact of desertification, soil erosion and deforestation that ultimately threaten our health. People’s insecurity is also increasingly bound up in the risks of becoming unemployed, and of being deprived of social and physical security. This is the outcome of a worldwide dominance of social institutions that lessen the daily experiences and ethical questions that exceed the limits of their internal criteria and logic. Needs, desires and imaginations that escape their logic are excluded, become objects of discipline, or are suppressed. They are seldom allowed to cause public debates about unforeseen consequences, nor about the ethical dilemmas of modern institutional ways to handle nature (including childbirth), to produce economic growth, or to control the victims of social and economic deprivation.

Nonetheless, Cathy McCormack (1994) created a stir when she declared that the ‘let’s all go jogging, stop smoking and eat brown bread’ type of health promotion campaigns have failed to reduce the health inequalities experienced by people subjected to modern-day poverty. Individualising the problem and the solution only damages the moral and spiritual health of the nation.

Modern day poverty is a worse killer than smoking – and it is also passive. That is why people in my community (i.e. Glasgow – EW) are convinced that as much passion must be applied to stubbing out poverty as is being applied to stubbing out smoking. We need homes that are fit to live in and incomes or benefits that prevent us from having to choose between heating and eating.

(McCormack 1994, 10)

McCormack (op. cit.) argued that health promotion should be concerned with living conditions because her own living conditions were not on an acceptable level for health. She argued that health promotion campaigns aimed at the individual do not make sense in the absence of adequate living conditions for human beings.

Health as defined by WHO comprises physical, mental and social well-being, and as an expression of trust in the present and in the future. Health is both a universal and a specific indicator for people’s experience of the quality of their environment and the social relations they share.

Well-being cannot be thought of without referring to trust. If people cannot have trust in themselves, they feel insecure. If they cannot have trust in the sustainability of the environment, they lose perspective on their lives and the lives of their children and future generations. If they cannot have trust in the Government, they feel aliena...